Basic Information
| Provider Information | |||||||||
| NPI: | 1831197920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDEIS | ||||||||
| FirstName: | JUDSON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARK PL STE 140 | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945834460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252557867 | ||||||||
| FaxNumber: | 9257254987 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 EAST ST | ||||||||
| Address2: | STE 240 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256896211 | ||||||||
| FaxNumber: | 9256893857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | A62541 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | GR0067920 | 05 | CA | MEDICAID | 340018831 | 01 | RR MEDICARE | OTHER |